RN Directs Future of Nursing Initiative

Susan Hassmiller, RN, PhD, FAAN, joined the Institute of Medicine in 2008 as the Future of Nursing study director and was the first person to come from outside the organization to lead an IOM initiative. In this unprecedented partnership, she worked with other IOM staff members to carry out a two-year investigation, resulting in the landmark report, “The Future of Nursing: Leading Change, Advancing Health,” released Oct. 5.

As the Robert Wood Johnson Foundation senior adviser for nursing, Hassmiller serves as director of the RWJF initiative on the Future of Nursing: Campaign for Action, a collaborative effort focused on implementing solutions to the challenges facing the nursing profession and preparing nurses to lead the change that will improve the quality and access of U.S. healthcare.

Nurse.com staff met with Hassmiller on April 4 at the RWJF corporate office in Princeton, N.J., to discuss the Campaign for Action, the challenges facing the nursing profession and what the initiative means for nurses now and in the future.

As you speak around the country on the initiative, what are you hearing from nurses and other groups about the report and its recommendations?

Without question, nurses are expressing tremendous gratitude for the initiative. They feel as though someone is finally paying attention to them and that something they really need is being worked on. They are also hopeful, because they know that there are many who are listening to the report, and that it is based on extensive work and research.

I also have heard concern and fear expressed, however, from physicians in particular, about the nursing scope of practice recommendations. When the report was released initially, there were some physician groups who wanted the IOM committee to retract some statements or change some language; the committee, of course, did not comply.

In addition, members of the American Association of Community Colleges thought we were suggesting that community colleges should close their doors, when in fact we acknowledge the community college as a viable and worthy pathway for nurses to begin their careers. We also recommend a whole tool chest of alternatives for RNs who need to obtain baccalaureate degrees, and the report suggests that resources currently supporting diploma programs could be better used in baccalaureate and graduate programs.

To better understand the recommendations, I encourage everyone to read the report on the IOM website. It can be downloaded for free at www.IOM.edu, and is available in print.

Do you think that we can reach the goal of having 80% of nurses with their baccalaureates by 2020?

Certainly, a lot has to happen in the next 10 years to reach that goal, and right now there are tremendous disincentives for nurses to return to school — so everyone will need to contribute to reaching that goal.

Community college faculty and administration should encourage students to continue their education beyond associate degrees, and universities need to welcome them by providing user-friendly options, such as more online courses and simulation programs.

RWJF has provided millions of dollars and hundreds of nursing scholarships, and other foundations have offered generous support as well, but the financial burden must be shared by all, including hospitals and other agencies that employ nurses and the state and federal government. Scholarships are especially important to help the profession attain more diversity. Businesses are getting more involved, and the Johnson & Johnson Campaign for Nursing’s Future has helped facilitate this movement.

More states should support the Oregon model of academic progression, which has a purposeful sharing of curricula, educational resources and faculty. More states also should follow what Florida has done by allowing community colleges to grant baccalaureate degrees in nursing. These kinds of models, including online programs, provide RNs cost-effective and convenient alternatives to obtain BSNs. There also are special AD-to-MSN programs, and BSN-to-PhD programs, which make sense and are efficient ways of obtaining a graduate degree. More students should be offered these opportunities to address the faculty shortage.

Recommending the year 2020 gives everyone a goal to work toward. Some employing agencies now are requiring a baccalaureate for new hires, and Magnet recognition requirements, career ladders with differential pay for baccalaureates and other education incentives indicate support for the recommendation.

How do you think staff nurses can become engaged in the Campaign for Action?

First, I’d like to emphasize that we have nurses at every level of care who possess leadership potential. Transforming Care at the Bedside, a RWJF initiative, underscores the leadership qualities of nurses who work on the front lines making critical patient care decisions.

An important message from the campaign is that all nurses can and should be leaders because leadership at every level is what is needed to ensure safe and high quality care. This means that nurses should be involved in making decisions about patient care and other aspects of healthcare delivery on their units, in their organizations and with professional organizations and policymakers.

Nurses should be involved in making all kinds of decisions from what technology they use to the roles they will play in the new accountable care organizations. They should convey real-time scenarios of how patient care can be improved and provide testimony about patient care at state and national legislatures. Nurses know what is best for their patients, and they should use their power to voice their opinions and concerns, backed by solid evidence.

We want everyone, both in and out of healthcare, to realize that the leadership roles nurses can and will have will make a difference in healthcare and its cost, quality, safety and access.

How will the regional action coalitions be supported in their early efforts?

The regional action coalitions are made up of those working at the grass-roots level — and they are getting the job done. We’ve formed a national partnership with AARP, the organization that is providing technical assistance to all of our regional coalitions and serving as our strategic partner overall. AARP has wonderful capacity and have become quite adept at helping states as they seek to adopt the IOM recommendations.

Technical assistance includes everything from grant writers and facilitators to webinars, issue briefs, connections to funders and help with overall infrastructure building and partnership development. In addition, we will be setting up learning collaboratives around special topics so states can learn best practices from one another. The foundation will monitor success at the national and state levels and construct a national dashboard so progress will be transparent.

This is a historic time for nurses where they have the opportunity to be involved in improving the healthcare delivery system. It is about nurses owning the responsibility for identifying gaps in the system as well as finding the solutions to address those gaps. It is always about the patients, first and foremost, and if we all remember that, it will give us the impetus to speak up and make a difference.

Are there any specific experiences in your nursing career that you believe led you to your position at Robert Wood Johnson Foundation?

I have always been drawn to public health nursing and public policy, and early in my career, I worked in public health settings at the local and state level and taught public health at two universities.

Since college, I have been involved in Red Cross disaster relief efforts in the U.S. and abroad, including tornadoes in the Midwest, Hurricane Andrew, 9/11 and others. I was the immediate past chairwoman of the national 9/11 Recovery Program, and I continue to work with the Red Cross as a member of the national nursing advisory committee and as a chair-elect of the Central New Jersey Red Cross. I recently served a six-year term as a member of the Board of Governors for the American Red Cross.

Before working at the foundation, I joined the Health Resources and Services Administration as executive director of the U.S. Public Health Service Primary Care Policy Fellowship where I worked on national and international primary initiatives.

When I joined RWJF, only two nursing programs were in place, and in 2002 we published a national report on the nursing workforce. After that, I was asked to lead a nursing team that focused on the work environment; that is how Transforming Care at the Bedside was created in 2008. When RWJF hired me in 1997, I was one of only two nurses.